Provider Demographics
NPI:1043933377
Name:LANGE, BRIANNA HART (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:HART
Last Name:LANGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2362 N OLD MILL LOOP
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4954
Mailing Address - Country:US
Mailing Address - Phone:208-209-5551
Mailing Address - Fax:
Practice Address - Street 1:2362 N OLD MILL LOOP
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4954
Practice Address - Country:US
Practice Address - Phone:208-209-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor